What is Atherosclerosis?
Atherosclerosis is a progressive disease involving plaque buildup in arteries, leading to narrowing, stiffness, and impaired blood flow. It is the root pathology behind heart attacks, strokes, and peripheral vascular disease.
Why Understanding Risk Factors Matters
Recognizing the risk factors empowers:
- Early prevention
- Targeted lifestyle changes
- Effective screening and medical therapy
80% of cardiovascular events are preventable by addressing modifiable risk factors.
Major Modifiable Risk Factors
As illustrated:
- Smoking
- Hypertension
- Diabetes mellitus
- Hyperlipidemia
- Cocaine use
- Increased fibrinogen
- Increased C-reactive protein (CRP)
- Low HDL cholesterol
- Increased homocysteine levels
We'll break each one down below.
Non-Modifiable Risk Factors
These cannot be changed but must be accounted for:
- Age (risk ↑ with age)
- Sex (men at earlier risk)
- Genetics (family history of heart disease)
- Ethnicity (higher risk in South Asians, African Americans)
Inflammatory Markers and Novel Risk Factors
✅ C-Reactive Protein (CRP):
- A marker of systemic inflammation.
- Elevated CRP predicts cardiovascular risk, even in patients with normal lipid levels.
✅ Fibrinogen:
- Increases blood viscosity and clot formation.
- High levels are associated with atherosclerotic plaque instability.
✅ Homocysteine:
- High homocysteine levels damage endothelial cells.
- May promote oxidative stress and thrombosis.
Smoking and Vascular Damage
- Damages endothelium
- Promotes LDL oxidation
- Increases platelet aggregation and fibrinogen levels
- Depletes nitric oxide → vasoconstriction
Stat:
Smokers have 2–4× higher risk of coronary heart disease compared to non-smokers.
The Silent Threat: Hypertension
- Causes endothelial microtears, allowing LDL infiltration
- Induces vascular remodeling
- Increases wall stress → plaque rupture
Often called the “silent killer”, hypertension is frequently asymptomatic.
Diabetes and Accelerated Atherosclerosis
- Chronic hyperglycemia leads to glycation of proteins
- Triggers inflammation
- Promotes oxidized LDL accumulation
- Damages vascular endothelium
Patients with type 2 diabetes have double the risk of cardiovascular events.
Dyslipidemia: The Cholesterol Connection
Atherogenic lipoproteins:
- High LDL → deposits cholesterol in arterial walls
- Small dense LDL is especially dangerous
- Triglycerides are also a risk enhancer
Statin therapy has transformed outcomes by lowering LDL.
Role of Low HDL and High Triglycerides
HDL (High-Density Lipoprotein):
- Removes cholesterol from plaques
- Anti-inflammatory and antioxidant
Low HDL (<40 mg/dL in men, <50 mg/dL in women) is associated with increased risk.
Cocaine Use and Sudden Arterial Spasm
Cocaine:
- Causes intense vasoconstriction
- Elevates sympathetic activity
- Can trigger coronary artery spasm, thrombosis, and infarction—especially in young individuals.
Biomarkers: Fibrinogen, CRP, Homocysteine
Fibrinogen
- Facilitates clot formation
- High levels predict myocardial infarction risk
CRP (C-Reactive Protein)
- Reflects vascular inflammation
- High-sensitivity CRP (hs-CRP) used in risk scoring
Homocysteine
- Elevated in vitamin B6, B12, folate deficiency
- Toxic to endothelial cells
Risk Factor Clustering: Metabolic Syndrome
When multiple risk factors cluster, it exponentially increases risk:
- Abdominal obesity
- High triglycerides
- Low HDL
- Hypertension
- Insulin resistance
This is termed metabolic syndrome—a red flag for future heart disease.
How to Modify Your Risk
Lifestyle:
- Quit smoking
- Eat Mediterranean-style diet
- Exercise 150 mins/week
- Maintain ideal body weight
- Sleep 7–8 hours daily
Medical:
- Statins for LDL
- ACE inhibitors for hypertension
- Metformin/GLP-1 agonists for diabetes
- Folic acid for homocysteine control
- Anti-inflammatory therapies (emerging)
FAQs on Atherosclerosis and Risk
Q1. Which risk factor is most dangerous?
Smoking and diabetes are top culprits—especially when combined.
Q2. Can atherosclerosis be reversed?
It can be stabilized or partially reversed with aggressive risk factor control, especially early on.
Q3. What lab tests assess cardiovascular risk?
- Lipid profile
- hs-CRP
- Fasting glucose/HbA1c
- Homocysteine (if suspected)
- Fibrinogen (in advanced settings)
Q4. Can young people get atherosclerosis?
Yes. Even subclinical atherosclerosis is detected in teens and 20s with poor lifestyle.
